Medication (generic)
Atorvastatin
Starting dose
10-20 mg once daily
Typical titration / target
40-80 mg daily for high-intensity
Monitoring / notes
Check baseline ALT; repeat if symptomatic.
Prescribing
Statin initiation
Common statin starting doses with intensity targets and monitoring reminders.
Last reviewed 2026-01-05|cardio | lipids | medication
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Dosing quick reference
Medication (generic)
Rosuvastatin
Starting dose
5-10 mg once daily
Typical titration / target
20-40 mg daily for high-intensity
Monitoring / notes
Use lower start in Asian ancestry or renal impairment.
Medication (generic)
Simvastatin
Starting dose
10-20 mg once daily
Typical titration / target
Max 40 mg daily
Monitoring / notes
Avoid strong CYP3A4 inhibitors and grapefruit.
| Medication (generic) | Starting dose | Typical titration / target | Monitoring / notes |
|---|---|---|---|
| Atorvastatin | 10-20 mg once daily | 40-80 mg daily for high-intensity | Check baseline ALT; repeat if symptomatic. |
| Rosuvastatin | 5-10 mg once daily | 20-40 mg daily for high-intensity | Use lower start in Asian ancestry or renal impairment. |
| Simvastatin | 10-20 mg once daily | Max 40 mg daily | Avoid strong CYP3A4 inhibitors and grapefruit. |
Contraindications
- Avoid in active liver disease or unexplained persistent severe transaminase elevation.
- Avoid with contraindicated interacting medications that markedly increase statin toxicity risk.
- Avoid initiation during pregnancy.
Renal and hepatic considerations
- Check baseline ALT and review hepatic history before initiation.
- Use conservative starts when renal impairment is present for dose-sensitive agents.
- Review interaction burden (including CYP-mediated interactions) before up-titration.
Pregnancy and lactation cautions
- Statins are generally not used during pregnancy; discontinue and reassess plan if pregnancy is planned or confirmed.
- Provide preconception counseling before long-term therapy in reproductive-age patients.
- Avoid routine statin use during lactation unless specialist-led risk-benefit justification exists.
Monitoring checkpoints
- Recheck lipids 6-12 weeks after initiation or titration.
- Review muscle symptoms and consider CK if severe.
- Reinforce lifestyle interventions alongside medication.
Stop or escalate criteria
- Stop and escalate for suspected rhabdomyolysis, severe myopathy, or significant hepatic injury signals.
- Escalate when LDL targets are not met despite adherence and tolerated dose optimization.
- Escalate early when adverse effects limit evidence-based intensity in high-risk patients.